In 2016, the executive leaders of the six Ottawa community health centres (CHCs) committed to creating a collaborative strategic plan. Creating a joint plan made sense given our ongoing collaborations as well as the shifts in Ontario’s health care system.
We’re proud to share our first annual report on our 2018-2020 collaborative strategic plan. Within this report you will find our significant shared accomplishments from the past two years, from creating an health team to responding to the pandemic.
For more than fifty years, community health centres (CHCs) have worked with and within marginalized communities to ensure that everyone in those communities receives equitable access to high quality health and social services. Programs and services are designed and implemented with a health equity lens—seeking to mitigate the barriers to community wellbeing and ensuring that our neighbours who are swimming against the currents of the social determinants of health are offered every opportunity to thrive.
As a network, the Ottawa CHCs employ more than 1,200 staff, engage approximately 1,376 volunteers and manage budgets totalling more than $106 million. With these significant resources, services are provided to more than 118,000 Ottawa residents facing barriers to health care and social services—a demonstration of the collective strength of these centres and the commitment to the pursuit of health equity in our city, and beyond. The Ottawa CHCs are regarded provincially as an example of how systems can be moved through leveraging of combined resources with a shared vision.
Health equity for all members of our communities: Working as a collective to address the systemic barriers and challenges to accessing health services.
In 2016, the executive leaders of the six community health centres (CHCs) in Ottawa took a bold step and committed to creating a collaborative strategic plan. This plan would build upon the collective strengths of organizations that already enjoyed a long of collaboration. Further, we anticipated a shift in the delivery of health services in Ontario. So, planning together positioned the Ottawa CHCs to collectively change. And, ensure that those communities most at risk of being left behind had a voice at the table.
Given the challenges of planning in an ever-changing healthcare environment, it was clear that an off-the-shelf strategic planning model would not meet the collective’s needs. After exploring a number of approaches, the decision was made to use Complexity Theory as the basis for our conversations and our plan.
Complexity dispenses with the idea that strategic plans need to fall within rigid three-year cycles, with a set of rigid indicators that may, over the course of the plan, become redundant or irrelevant. Complexity Theory allows the health centres to focus on a single objective, called the North Star, that will not change over time.
The Ontario government has quadruple aim aspirations as it transforms healthcare:
Improved client-caregiver experience with the health care system.
Improved clinician’s experience in delivering care.
Optimal value for investments in the health care system.
Improved population health as a result of better coordination at the system level.
These aims were central in our thinking as the conversations moved ahead.
The process of getting to the plan involved the creation of a comprehensive environmental scan, followed by engagement with boards and senior staff at all six centres. In the end, the group landed on the following elements for its 2018-2020 plan.
The North Star was determined to be health equity for all members of our communities. The three strategic priorities that will guide us there:
Accessibility: ensuring that all programs and services offered in our CHCs are barrier-free and enhancing access for people with complex needs;
Quality through impact: ensuring that all programs and services offered are grounded in evidence and demonstrate a commitment to be the best available;
Leveraging our collective capacity: ensuring that we take every opportunity to influence our environment and to deliver and evaluate our services in a way that takes advantage of the strengths of each organization, as well as the strength realized by speaking with one voice on matters that impact our communities.
The strategic result of these efforts will be that more people with complex needs will have access to services that are attributable to the CHC Model of Health and Wellbeing.
With the planning framework in place, the executive leaders and their teams at the six CHCs created projects and initiatives that would advance the work of their organizations, using the resources of the collective. The CHCs agreed to set objectives to be accomplished in a two-year window, ending March 31, 2020. They would then evaluate, take stock and look ahead to the next set of objectives. Keep reading for examples of how the CHC Collaborative used the strategic plan to realize some important gains.
When the six Ottawa Community Health Centres (CHCs) embarked on the development of a collaborative strategic plan, it was done in anticipation of significant changes to the way that health and social services would be delivered in Ontario
With the Minister’s announcement in April 2019 of the province’s shift from Local Health Integration Networks (LHINs) to a model called Ontario Health Teams (OHTs), the six CHCs recognized an opportunity to bring the strategic plan to life. The executive leaders of the Ottawa CHCs approached their boards with the idea of convening an OHT in Ottawa that was rooted in community health rather than acute care. And, with a particular focus on ensuring that those most in need were the highest priority. This recognized that most healthcare is delivered in the community, not in critical care hospital settings. Once established, this team would drive the delivery of healthcare in Ontario for the next generation.
A convening partner’s table was assembled that included 11 organizations: the six CHCs, Ottawa Inner City Health, The Ottawa Hospital, Bruyère Continuing Care, Ottawa Public Health and Carefor. Each organization invited to that table brought resources and experience that would serve the development of the application (called a Readiness Assessment) to the Ministry to form an OHT. And, would support the team’s work in the first year. An invitation was issued to the community to join the team. By the time the Readiness Assessment was submitted to the Ministry, more than 60 community organizations had signed on as partners. The enthusiasm was and remains palpable.
After six more months of hard work, we received word on December 6, 2019 that the Ottawa Health Team-Équipe Santé Ottawa (OHT-ESO) was included as one of the province’s first 23 OHTs to be approved. Two populations were identified for our initial focus in the first year:
People struggling with mental health and substance use who are frequent users of emergency departments.
Frail older adults aged 55+ who are on low income with limited supports and who have complex needs.
Action teams have been formed around both of these groups and work is underway.
The OHT-ESO has committed to a development model that is inclusive and takes into account the input from a broad stakeholder group. We have convened a Client Partner Table that will give voice to the people in our community who have lived experience in the healthcare system. We are determined to engage with these partners in co-designing the new system. In the past, those who use the services have too often been relegated to the sidelines. We are also seeking to establish a table of primary health care clinicians—physicians and nurse practitioners—to ensure that the voices of those delivering front-line primary care are heard.
While we have made some gains, there is still much to do. COVID-19 has impacted on our planning and some work has had to be paused to allow organizations to pivot towards the pandemic response. We have maintained regular meetings of the 11 convening OHT-ESO partners and have also used the learnings from the pandemic to seek out opportunities to leverage the collective strengths of the community to address emergent issues.
When COVID-19 struck, the six Ottawa community health centres (CHCs) quickly pivoted to direct time and resources toward those who we knew would be most profoundly impacted by the lockdown. Issues such as food isolation, substance use and access to technology all became critical needs for those who struggle at the best of times. New partnerships formed and funders offered flexibility in how dollars and human resources would be used to support the response.
Very early in the pandemic lockdown, the Distress Centre crisis support line reported a sharp increase in the number of calls it was receiving related to depression and anxiety. With the normal resources, such as walk-in clinics and primary care offices unavailable, and being asked to stay away from emergency departments, people were turning to the Distress Centre. But, those volunteers skilled at crisis situations provide different than full-length counselling sessions.
Members of the Mental Health and Addictions Primary Care Action Team (MHAPCAT) of the Ottawa Health Team-Équipe Santé Ottawa (OHT-ESO) recognized the challenge and proposed a solution: pooling the resources of counselling agencies and creating an on-line platform called Counselling Connect where clients self-refer for a same-day or next-day phone or video counselling session. The staff who would normally provide counselling in person could offer sessions on-line and by phone.
A proposal was developed and funding was secured from a generous private donor through the Ottawa Community Foundation. This allowed the initiative, Counselling Connect, to be launched in mid-May. So far, 14 organizations are providing same-day and next-day counselling sessions to all ages.
Counselling Connect provides free access to a same-day or next-day phone or video counselling session for residents of Ottawa and the surrounding area. Services are offered in both official languages and across the lifespan. Through a single user-friendly website, individuals can book a 45- to 90-minute counselling appointment with a mental health professional from one of participating community mental health and addictions agencies at a time that is convenient for them. Clients select from six service areas, including:
Adult and older adult mental health (21 years and older)
Adult and older adult substance use, gambling, and gaming (25 years and older)
Youth, young adult and family mental health (12-21 years)
Youth, young adult substance use, gambling, and gaming and support for their families (12-25 years)
Children and family mental health (children under the age of 12 and their families)
Indigenous Counselling (lifespan)
People can self-refer and book their own appointments. Other service providers, including the Distress Centre and Canadian Mental Health Association, also have access to book client appointments.
As of mid-July, 1,053 counselling appointments have been booked through Counselling Connect since the public launch on May 14th. 75 per cent of these appointments are booked through the Counselling Connect website. 25 per cent of appointments are booked through other partner organizations such as the Ottawa Distress Centre and the Canadian Mental Health Association Ottawa branch. Funding from United Way East Ontario, in addition to the Ottawa Community Foundation funding, is making this service available until at least March 31, 2021.
Through the COVID-19 experience, we recognize that the way we deliver services will change forever. In fact, many of the innovations that we have undertaken in response to the pandemic have actually increased access for many of our clients. Out of crisis and necessity, changes that would have previously taken months or years happened in weeks.
The community health centres (CHCs) all adapted to meet the emergent needs of those facing the most barriers as COVID-19 took hold. It became clear early on that the cracks we knew about in our social infrastructure were widening. From public showers and WiFi, to food banks and drop-ins, the usual resources suddenly vanished. People struggled to maintain their necessities of life in an environment where critical services were widely disrupted.
Staff in CHCs were re-deployed in ways that allowed services to be sustained, using technology and creativity. Virtual delivery of health and social services was ramped up very quickly and successfully in all centres. This reduced in-person traffic at sites and protected staff and clients from infection. For the Ottawa CHC with a consumption and treatment service, there was an increased need for vigilance. People were using drugs alone during lockdown and disrupted international supply chains led to an increasingly unpredictable and tainted drug supply.
Food insecurity was amplified by the requirement to self-isolate. CHCs supported partners in food systems and ensured that those who needed food were given access—through food banks, food cupboards and meal deliveries.
The CHCs are part of the City of Ottawa’s Pandemic Plan. A number of our clinical and allied health staff answered the call to support testing efforts and were redeployed to COVID-19 assessment centres. We were also asked to participate in a number of task and working groups to plan during the pandemic and to plot the course ahead as we moved into the recovery phase of the crisis.
During the pandemic, the CHC executive leaders met virtually weekly to plan and share directions and strategies. A human resources working group was established to assist centres in understanding and applying the government programs that were made available to support staff and organizations through the lockdown. Looking after our staff and those they care for was a priority in all organizations throughout lockdown and as we restarted programs safely.
In all, the partnership between the Ottawa CHCs was a significant lever to ensure our clients and our staff were cared for as we navigated the pandemic together.
In health systems, there is a growing need to provide evidence that what an organization is doing justifies the investments being made. Funding is tied to data. Community health centres (CHCs) have a long track record of working with communities to improve health outcomes. Our clients are often disproportionately impacted by the social determinants of health. We are able to tell stories of lives changed and innovative solutions to complex problems. Further, we have always relied on evidence, qualitative and quantitative, to help us drive change. As individual CHCs, all of our programs are evaluated. That information is used to further program development and determine if the initiative has successfully addressed the community need, as intended.
It occurred to the six Ottawa CHCs that it would be useful to harmonize and aggregate our individual data. This would allow us to define and quantify our collective impact on removing barriers to excellent health and community services; to help to tell the bigger story of how CHCs enhance the lives of the people we serve in Ottawa.
A working group was assembled that included an executive leader, data management coordinators from all CHCs, health planners, decision support specialists and program managers. Over the course of a year, this team collected, collated, cleaned and sorted the mounds of individual CHC information into a data story.
The report that was produced captures an aggregated view of the communities and populations served by CHCs, applying a health equity lens to highlight community health centres’ strong reach to people who face many barriers. Of particular interest is the sociodemographic picture that the data paints through the attention paid to equity groups, Francophone, Indigenous, racialized and LGBTQ2S+ populations. We also took a close look at education and income levels, newcomers and people with first languages other French and English.
In order to inform the work of the Ottawa Health Team-Équipe Santé Ottawa (OHT-ESO), priority client groups (older adults aged 55+ with limited financial and social supports and adults with mental health and substance use issues) were mapped to the team’s attributed population. This information was used to inform the Ottawa Health Team-Équipe Santé Ottawa and to guide the work of its action teams.
The commitment is to continue to refresh and expand this work and to use the evidence gathered to advance the strategic goal of health equity for everyone in our communities—our North Star.